Cases of monkey pox (Monkeypox) not directly linked to travel to Central or West Africa or people returning from travel have been reported in Europe and around the world since the beginning of May 2022. Since this date , the epidemic is affecting a growing number of countries and the disease is the subject, in France and in Europe, of heightened surveillance.
In France, orthopoxvirus infections are subject to long-term monitoring through the mandatory notification system. Given the current epidemic, surveillance of these infections has been reinforced by Public Health France and information and alert messages have been sent to healthcare professionals and the populations most at risk.
Due to increased delays in collecting information on recently observed cases, the total number of confirmed cases published today includes catch-up data. The increase in the number of cases since the last report published is spread over the last few weeks and should not be interpreted as an exceptional increase, although an upward trend is nevertheless observed. Data for cases identified to date are presented as of the date of onset of symptoms or, if unknown, as of the date of report. This has no impact on patient information and care.
As of July 19, 2022 at 12:00 p.m., 1,453 confirmed cases have been identified in France; by department of residence, 678 cases reside in Ile-de-France, 111 in Occitanie, 103 in Auvergne-Rhône-Alpes, 65 in New Aquitaine, 55 in Provence-Alpes-Côte d’Azur, 41 in Hauts-de- France, 25 in Grand Est, 18 in Normandy, 15 in Pays-de-la-Loire, 9 in Bourgogne-Franche-Comté, 9 in Centre-Val de Loire, 9 in Brittany and 1 in Martinique. The region of residence is not given for 309 cases and 5 cases live abroad.
The distribution of cases by region of residence (when known) is shown in Figure 1 for cases residing in France. That by reporting region is shown in Figure 2.
Figure 1. Confirmed cases of monkeypox (n=1,139 cases) by region of residence, France, May-July 2022 (data as of 07/19/2022 – 12:00 p.m.)
Figure 2. Confirmed monkeypox cases (n=1,440 cases) by reporting region, France, May-July 2022 (data as of 07/19/2022 – 12:00 p.m.)
The distribution of cases by symptom onset date (when known) is shown in Figure 3. The symptom onset date for these cases ranges between May 7, 2022 and July 15, 2022. They have were diagnosed a median of 6 days (between 0 and 23 days) after the onset of symptoms; therefore, data for the last week is not consolidated.
The reports received do not always mention the date of onset of symptoms or the date of diagnosis of the patient. As an alternative to this information, the distribution of cases according to their date of reporting is presented in Figure 4.
Figure 3. Confirmed cases of monkeypox (n=1,087 cases) by date of onset of symptoms, France, May-July 2022 (data as of 07/19/2022 – 12:00 p.m.)
Figure 4. Confirmed cases of monkeypox (n= 1,299 cases) by date of report, France, May-July 2022 (data as of 07/19/2022 – 12:00 p.m.)
All cases identified to date, except 6 adult females and 2 children, are adult males. Adult cases range in age from 18 to 84 (median age: 36).
Among the cases investigated, 78% presented a genito-anal rash, 72% an eruption on another part of the body, 76% a fever and 74% lymphadenopathy. No case died.
The median time to use the test per screening week has been decreasing since the start of the epidemic: it fell from 13 days in S18-2022 (May 2 to 8) to 5 days in S26-2022 (July 4 to 10 ).
Among the cases investigated, 49 are immunocompromised; 274 (26%) are HIV positive. Among HIV-negative cases, 513 (69%) are on PreP.
To date, in France, 96% of cases for which sexual orientation is reported have occurred among men who have sex with men (MSM). Among the cases for which information is available, 74% declare having had at least 2 sexual partners in the 3 weeks before the onset of symptoms.
Most of the cases questioned declare that they cannot identify the person who allegedly contaminated them; 212 are secondary cases, ie reporting having been in contact with a case of monkeypox in the three weeks preceding the onset of symptoms.
The next update of this report will take place on Friday July 22, 2022.
Information and prevention actions
Given what has been observed in Europe on the disease, targeted communication was quickly implemented towards MSM people. The website sexosafe.fr, dedicated to the sexuality of MSM people, is regularly updated with a summary of knowledge on the subject and prevention measures. The messages recalling the symptoms and what to do in the event of symptoms were relayed via a digital campaign. Since June 17, the digital campaign has generated nearly 348,592 clicks on the banners and more than 292,993 visits to the Sexosafe site. This device was supplemented with a poster campaign in places of conviviality with nearly 1,350 poster spaces. And since a few days by broadcasting spots on community radios. At the same time, posters, flyers and advice sheets were distributed thanks to associations, ARS and Sexosafe teams present in the field, as part of pride marches and in places where MSM meet. To date, 2,657 posters and 80,100 flyers have been ordered.
In the coming days, a digital campaign on preventive vaccination and tools for the field will also be made available, following the publication of theopinion of the High Authority for Health of July 07.
Prevention actions are continuously adapted to the evolution of the situation and the state of knowledge.
In the usual absence of monkeypox in Europe and of a link reported by the cases identified with a risk zone, the current European context constitutes an alert and suggests contamination in Europe. This is why, in France, the long-term monitoring of monkeypox through the mandatory notification system is reinforced and information and alert messages are sent to health professionals.e. Exchanges are also continuing with other European countries, the WHO and the ECDC.
Monkeypox info service: a listening device to answer questions about monkeypox
Since Wednesday, July 13, a listening device has been open to answer questions raised by monkey pox. Subsidized by Santé publique France and supported by SIS Association (Sexualités info service Association), the “Monkeypox info service” telephone line is accessible every day from 8 a.m. to 11 p.m., on the toll-free number 0 801 90 80 69 (free call and services, anonymous and confidential) This system is responsible for supporting prevention messages and protective measures, providing information on symptoms, treatments and vaccination, advising and directing people to treatment systems.
- Since the opening of the line, 879 requests have been processed on the Monkeypox info service line, 91% of them from men, with an average age of 39 years.
- Less than half of callers (41%) declare a risk of exposure and 12% of callers say they have the virus.
- The theme mainly mentioned is the means of prevention: 9 requests out of 10 relate to access to the vaccine. Among these requests related to the vaccine, the main concerns regarding the accessibility of vaccination and requests for addresses of vaccination centers.
- Callers also wonder about the symptoms, the risks of transmission and testify to their concerns about the transmission of the virus.
Preventive vaccination against monkeypox
Faced with the spread of the Monkeypox virus (monkey pox), the High Authority for Health, seized by the Directorate General for Health, recommended in its opinion of July 7, 2022 that preventive vaccination be offered to the groups most exposed to the virus.
Thus, since July 11, 2022, in addition to people who have had risky contact with a sick person, people falling within the indications retained by the HAS can make an appointment to be vaccinated throughout the country:
- Men who have sex with men reporting multiple sex partners.
- Trans people reporting multiple sexual partners.
- People in prostitution.
- Professionals working in places of sexual consumption.
Vaccination can also be considered on a case-by-case basis for health professionals who have to take care of sick people.
For more information on vaccination and access to vaccination sites:
What is monkey pox (Monkeypox)?
Monkeypox is an infectious disease caused by an Orthopoxvirus. This zoonotic disease is usually transmitted to humans in forest areas of Central and West Africa by wild rodents or primates, but human-to-human transmission is also possible, particularly within the family home or in the care setting.
How is it transmitted?
The monkeypox virus can be transmitted by direct contact with lesions on the skin or mucous membranes of a sick person, as well as by droplets (saliva, sneezing, sputter, etc.). Sexual intercourse, with or without penetration, meets these conditions for contamination, and having several partners increases the risk of being exposed to the virus. In particular, direct contact with damaged skin during sexual intercourse facilitates transmission.
Contamination can also occur through contact with the patient’s environment (bedding, clothing, dishes, bath linen, etc.). It is therefore important that the patients observe isolation throughout the duration of the disease (until the disappearance of the last scabs, most often 3 weeks).
In Central or West Africa, humans can also become infected through contact with animals, wild or in captivity, dead or alive, such as rodents or monkeys.
What are the symptoms ?
Infection with monkeypox virus can cause a blistering rash, made up of fluid-filled blisters that progress to drying, crusting and then scarring. Itching may occur. The vesicles are more concentrated on the face, in the ano-genital area, the palms of the hands and soles of the feet, can be present but also on the trunk and the limbs. The mucous membranes are also affected, in the mouth and the genital area. This rash can be accompanied by fever, headache, body aches and asthenia. Lymph nodes may be swollen and painful, under the jaw, in the neck or in the fold of the groin. Sore throats are also reported.
The incubation of the disease can range from 5 to 21 days. The fever phase lasts about 1 to 3 days. The disease most often heals spontaneously, after 2 to 3 weeks but sometimes 4 weeks.
Is monkeypox serious?
The disease is more severe in children and in immunocompromised people. It can be complicated by superinfection of skin lesions or by respiratory, digestive, ophthalmological or neurological disorders.
In Europe, 2 deaths (Spain) have been reported to date.